Provider Demographics
NPI:1336707462
Name:SHAFIK, ADAM O (DDS)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:O
Last Name:SHAFIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:165 CAMBRIDGE ST STE 401
Mailing Address - Street 2:MGH DENTAL GROUP
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2750
Mailing Address - Country:US
Mailing Address - Phone:617-726-1076
Mailing Address - Fax:
Practice Address - Street 1:165 CAMBRIDGE ST STE 401
Practice Address - Street 2:MGH DENTAL GROUP
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2750
Practice Address - Country:US
Practice Address - Phone:617-726-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL13949204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery